Child needs surgery in CA; must come to US

[Laurie4b]

http://video.foxnews.com/v/4287664/a-new-face-for-maddox

 

 

What's up with this? I thought the Canadian health care system would have covered necessary surgery like this. Instead, the child had to come to the US and the operation had to be paid for with private funds despite having a public health care system. How can a health care system deny surgery like this? I wonder if this is what we're in for in the U.S.

[katemary63]

This just makes me mad. It was specifically stated that this surgery is "not available in his country." We're fools. We've messed with the best health care system on earth.

[Melinda in VT]

This just makes me mad. It was specifically stated that this surgery is "not available in his country." We're fools. We've messed with the best health care system on earth.

 

How rare is this condition?

 

The population of the U.S. is almost 10 times the population of Canada. It makes sense that there will be some rarer procedures that are not available in Canada simply because there aren't enough people in Canada with that condition.

 

Is it possible this is one of those cases?

[Laurie4b]

How rare is this condition?

 

The population of the U.S. is almost 10 times the population of Canada. It makes sense that there will be some rarer procedures that are not available in Canada simply because there aren't enough people in Canada with that condition.

 

Is it possible this is one of those cases?

 

I'm sure that's possible; I'm not a medical professional, so I have no way of knowing. (I do know that for huge facial tumors, that Mercy Ships ministry travels to third world countries with volunteer docs from the US who remove the tumors. I don't know if this one was different because of the lymph system. BUt if you can get enough docs from teh US to volunteer their time to remove huge tumors, it doesn't seem like it's that rare.)

 

But the question of frequency of occurrence aside, the other question remains: why didn't their health care system pay for it since the child clearly needed it? If they didn't have a doctor in Canada who could perform the surgery , why didn't their health care system arrange for it to de done? Why did the family have to raise money for the surgery? I cannot imagine thinking I had health care coverage from my government and having a child with that condition and being denied payment for the operation that he clearly needed.

Edited July 21, 2010 by Laurie4b

[JoyfulMama]

Is it possible that the medical care was covered, however travel and lodging for family and child were not? I'm looking for another reference to this case....

[thescrappyhomeschooler]

This might be a controversial statement, but just because we have the best surgeons in the world, doesn't mean we have the best health care system in the world.

 

Close friends of ours who worked their whole lives- the husband over 25 years at the phone company and the wife 22 years at a large bank- lost everything they had ever had because of one surgery. The husband had to have open heart surgery and things went wrong. He wasn't able to go back to work and lost his health insurance along with his job. His wife was then laid off a year later, and they had so many medical bills, they lost their house, their car and their entire retirement savings. Only now that they are completely destitute do they qualify for any aid from the government. Something seems terribly wrong with this system to me.

[Melinda in VT]

But the question of frequency of occurrence aside, the other question remains: why didn't their health care system pay for it since the child clearly needed it? If they didn't have a doctor in Canada who could perform the surgery , why didn't their health care system arrange for it to de done? Why did the family have to raise money for the surgery? I cannot imagine thinking I had health care coverage from my government and having a child with that condition and being denied payment for the operation that he clearly needed.

 

I don't think there is a country on earth that guarantees every medical procedure will be covered. Nor do I think that is a realistic goal.

 

I don't know the details of this case. I'm not saying this surgery should not have been covered. But as to the larger issue? I completely expect that under any insurance system (government or private) there will be procedures that aren't covered.

[emubird]

Instead, the child had to come to the US and the operation had to be paid for with private funds despite having a public health care system. How can a health care system deny surgery like this? I wonder if this is what we're in for in the U.S.

 

And this is somehow different from having an insurance company deny coverage, which they do all the time?

 

If the appeal to cover the first surgery is successful, I rather doubt Fox news will carry that.

[smrtmama]

This might be a controversial statement, but just because we have the best surgeons in the world, doesn't mean we have the best health care system in the world.

 

 

I don't even think we have the best surgeons on the world. I just think we have the most surgeons and that means a greater chance for highly specialized care. That isn't changing simply because healthcare is being covered for people who otherwise wouldn't be able to afford any care, let alone specialized.

[EKS]

And this is somehow different from having an insurance company deny coverage, which they do all the time?

 

 

 

Exactly!

[JoyfulMama]

Here is a quote from a news story:

 

Alberta Health Services announced late last week the province would cover the cost of Monday's surgery, but not the first $50,000 procedure in May.

While the family is appealing the decision, they are glad donations mean Maddox won't have to wait for his second and final procedure.

 

 

http://www.ctv.ca/CTVNews/Canada/20100718/maddox-flynn-surgery-100719/

 

 

Thanks, Julie!

 

I think the difficulty here is the flawed thinking that all available procedures in the US should all be covered at a low cost to all individuals. While it is true that no person can be turned away from receiving NECESSARY care at an emergency room, regardless of their ability to pay, there is a pricetag to everything.

In CA, that pricetag is paid via income taxes, sales, taxes, lottery procedes, and (in some provinces) premiums. Individuals can purchase private insurance to supplement the BASIC SERVICES not covered by the Canada Health Act.

In the US, that pricetag is paid by the individual, who is responsible for payment, and is also responsible for seeking out assistance based upon financial need, which must be proven. The fed government enacted Medicaid and Medicare in order to assist those who could not pay for medical care (the young, the poor, the disabled, the elderly) to obtain medical care. Many are eligible to purchase health insurance, to assist with negotiating prices for services. The insurers, who dictate which percentage the individual will pay based upon a contract, both with the individual and the providers. Laws have been enacted in many states to require insurance companies to cover specific procedures.

In both circumstances, there are procedures that are not covered, or that simply have a high pricetag, either because they are extremely costly (someone will want to be paid for services), or because they are not provided enough to be justified to the masses.

Procedures that have a high cost should be able to charge an equally high pricetag. Somewhere, somehow, the costs of the procedure must be met, or the procedure won't be performed. Yes. Money does make the world go round. :glare:

How much money I have determines how full I can fill my grocery cart, how big of a house I live in, and how many clothes I have in my closet. It does not prevent me from getting necessary treatment in an emergent situation, but it will have an impact on the continued care I receive. That is the same, whether I live in CA or the USA.

[Haiku]

I cannot imagine thinking I had health care coverage from my government and having a child with that condition and being denied payment for the operation that he clearly needed.

 

I cannot imagine thinking I had health care coverage from my insurance company and having a child need care and being denied payment for the care that he clearly needed.

 

Oh, wait, yes I can, because it's happened to us. :thumbdown: And we even get the privilege of paying over a thousand dollars a month in premiums so that we can be turned down for care! :D

 

Tara

[Laurie4b]

Here is a quote from a news story:

 

Alberta Health Services announced late last week the province would cover the cost of Monday's surgery, but not the first $50,000 procedure in May.

While the family is appealing the decision, they are glad donations mean Maddox won't have to wait for his second and final procedure.

 

http://www.ctv.ca/CTVNews/Canada/20100718/maddox-flynn-surgery-100719/

 

From what I gather from reading other news stories (PLEASE correct me if I'm wrong) the government isn't at first paying for the first procedure because what happened was the family went ahead and got it done without waiting for the government to reply to there request. This isn't a life threatening problem and the family went ahead and got it done immediately instead of giving the government time to reply to the request. The reason the family went ahead with it is that the newspaper got a hold of the surgery and donations started to pour in. The family is appealing the decision that the government isn't paying the FIRST surgery and only all the ones after it.

 

Personally I would rather a bit (For a non life threatening disease) and have it paid for then live in the US and have to cover the price of the surgery with will be Hundreds of Thousands of dollars at the very least - or if I can't pay simple not have the surgery.

 

The reason Canada wasn't able to perform the surgery itself is compared to the US we are population wise a small country.

 

309,786,000 is the population of the US (4.52% of the world population)

34,180,000 is the population of Canada (0.5% of the world population)

 

Populations form Wiki.

 

Since the population of the US is so much larger it isn't a surprise that the US has better facilities and specialists to perform some very specialized surgeries.

 

The tumor had already cost him the loss of sight in his eye , according to the video on the site you linked. The article you cite also noted that it was affecting him socially in profound ways--other children would run crying from him. Those consequences are not "life-threatening" but they are life-changing.

 

Are you serious when you say you'd just wait if something was not life-threatening and you wouldn't have tried to get what your child needed however you could? Do you honestly not consider loss of sight and the lack of normal social interaction important enough reasons to take things into your own hands as a parent? The child was born with the disease; he was two when he got the surgery. Googling the disease, it seems the tumors grow slowly, so there would have been time to get approval if the health care system was going to approve it. I am wondering if the surgery was approved only after public outcry, not because the parents jumped the gun.

Edited July 24, 2010 by Laurie4b

[Renee in NC]

The tumor cost him the loss of sight in his eye, according to the video on the site you linked. Of course, that wasn't life-threatening.... and the article you cite also noted that it was affecting him socially--other children would run crying from him. That's not life-threatening either. Are you serious when you say you'd just wait around if something was not life-threatening and you wouldn't have tried to get what your child needed however you could?

 

Most people would have to. If an insurance company won't pay for something, you either wait for the appeals process or you pay for it yourself. Even if you have insurance, a non-life threatening procedure requires that you pay the co-pays and co-insurance up front. If you don't have the money to pay that, you either wait while you save it up or you have fundraisers - the same as these parents did.

 

Health care is rationed in this country as well - this isn't a Canada problem. If they had waited, the gov't probably would have paid for the first surgery.

[Laurie4b]

Most people would have to. If an insurance company won't pay for something, you either wait for the appeals process or you pay for it yourself. Even if you have insurance, a non-life threatening procedure requires that you pay the co-pays and co-insurance up front. If you don't have the money to pay that, you either wait while you save it up or you have fundraisers - the same as these parents did.

 

Health care is rationed in this country as well - this isn't a Canada problem. If they had waited, the gov't probably would have paid for the first surgery.

 

I think I would have gone to the media, like this couple did--whatever health care system I was a part of. If I had private insurance, I would make sure people knew they wouldn't pay for this necessary surgery--same if I was a Canadian citizen and they wouldn't put until (apparently) there was media pressure.

 

I think it's outrageous that it went this far before the child got the care he needed. I would think so whether he had private insurance or govt insurance. However, the implication of govt insurance to me is that you do get what you need without going broke. I don't expect that from every private insurance plan. But I would expect any insurance plan--private or govt--to have the moral obligation to cover that surgery.

[astrid]

And this is somehow different from having an insurance company deny coverage, which they do all the time?

 

If the appeal to cover the first surgery is successful, I rather doubt Fox news will carry that.

 

YES! EXACTLY!

Thank you, Emubird!!

 

astrid

[kokotg]

A quick google search for "insurance company denies surgery" is a fascinating read. I could post a story like this from some local news outlet in the US every day and never run out. The fact that it makes national news when it happens in Canada might be the real story here.

[Haiku]

The fact that it makes national news when it happens in Canada might be the real story here.

 

:iagree:

 

Tara

[cathmom]

A quick google search for "insurance company denies surgery" is a fascinating read. I could post a story like this from some local news outlet in the US every day and never run out. The fact that it makes national news when it happens in Canada might be the real story here.

 

:iagree:

[SonshineLearner]

I think that our Healthcare system will be just as great as all the other programs our Government runs.... I mean... when the government is involved and dictates... just look at the lovely public schools they charge all of us for... on behalf of "the people". I look forward to having one more thing under it's rule. My friend from France told us of the character development that you can achieve while waiting for something like a simple procedure there...

;)

[JoyfulMama]

My friend from France told us of the character development that you can achieve while waiting for something like a simple procedure there...

;)

 

:lol:

OK. Maybe not supposed to be funny, but... :lol:

[asta]

I cannot imagine thinking I had health care coverage from my insurance company and having a child need care and being denied payment for the care that he clearly needed.

 

Oh, wait, yes I can, because it's happened to us. :thumbdown: And we even get the privilege of paying over a thousand dollars a month in premiums so that we can be turned down for care! :D

 

Tara

 

Apparently, some other insurers decided to follow their lead:

 

Some insurers stop writing new coverage for kids

"Ahead of requirement to cover kids with medical problems, some insurers drop out"

 

(it's not from Fox, people...)

 

 

a

[PiCO]

I don't even think we have the best surgeons on the world. I just think we have the most surgeons and that means a greater chance for highly specialized care. That isn't changing simply because healthcare is being covered for people who otherwise wouldn't be able to afford any care, let alone specialized.

 

I think we will see a change. I think the best and the brightest will start looking for careers other than surgery, because they don't want to be government employees.

[hornblower]

Canada does pay for out of country surgery if

1) it's required

2) it's not experimental

3) it's not avail in Canada (& as people said, we're a large country with a small population - we just don't have every expert out there)

 

This family applied for this coverage & then chose not to wait for the panel to make their decision (which can take 60 days). This boy's sight was already affected & nothing I read indicated that doing the surgery in May vs. 60 days later would change that.

 

Everybody has the option of paying out of pocket for procedures out of country & that is ultimately what this family chose to do with the first surgery. The subsequent surgery will be covered.

 

Remember too that all his post op etc care once he returned home is covered under our medical system. It's a sweet deal.

[asta]

It's a sweet deal.

 

I understand your point. Really, I do.

 

I guess I've just had a bad week. Year. Decade.

 

I'm sick of living in socialist countries.

 

I'm ready to move back to a standard republic w/ evil capitalism. If it's still there by the time I can get back...

 

 

a

[Amy in NH]

I think that our Healthcare system will be just as great as all the other programs our Government runs.... I mean... when the government is involved and dictates...

 

I can tell you from personal experience that the medical and dental coverage my children have under government-run Medicaid is far superior to the can't-afford-the-copay-to-see-the-doctor-for-an-obvious-infection care I get under my husband's crappy employer-sponsored health insurance plan.

[hornblower]

 

I'm sick of living in socialist countries.

 

 

Yeah, but generally speaking, if you're going to get sick, it's best to do it in a socialist country. :lol:

[higginszoo]

 

Remember too that all his post op etc care once he returned home is covered under our medical system. It's a sweet deal.

Sometimes this is the case, but not always. A friend's ds has the same rare genetic disorder my ds has. They're in Ontario, and there is only one specialist who has the knowledge to treat this. Not only can they not get approval to go to this specialist in Vancouver, but they've been told that if they opt for surgery at Shriner's in Erie, PA (all children with this disorder are generally automaticall accepted at Shriners, which covers all care at their facilities), none of his followup care will be covered in Canada. They're in a tight spot, and while the appeals go on for years, their little boy has lost his ability to walk and is confined to a wheelchair until it's all settled.

[elizabeth]

This might be a controversial statement, but just because we have the best surgeons in the world, doesn't mean we have the best health care system in the world.

 

Close friends of ours who worked their whole lives- the husband over 25 years at the phone company and the wife 22 years at a large bank- lost everything they had ever had because of one surgery. The husband had to have open heart surgery and things went wrong. He wasn't able to go back to work and lost his health insurance along with his job. His wife was then laid off a year later, and they had so many medical bills, they lost their house, their car and their entire retirement savings. Only now that they are completely destitute do they qualify for any aid from the government. Something seems terribly wrong with this system to me.

 

I agree with your analysis. If I could put gold stars around your words, I would.

[Caitilin]

I can tell you from personal experience that the medical and dental coverage my children have under government-run Medicaid is far superior to the can't-afford-the-copay-to-see-the-doctor-for-an-obvious-infection care I get under my husband's crappy employer-sponsored health insurance plan.

 

 

Amen. This is SO true.

[Audrey]

Canada does pay for out of country surgery if

1) it's required

2) it's not experimental

3) it's not avail in Canada (& as people said, we're a large country with a small population - we just don't have every expert out there)

 

This family applied for this coverage & then chose not to wait for the panel to make their decision (which can take 60 days). This boy's sight was already affected & nothing I read indicated that doing the surgery in May vs. 60 days later would change that.

 

Everybody has the option of paying out of pocket for procedures out of country & that is ultimately what this family chose to do with the first surgery. The subsequent surgery will be covered.

 

Remember too that all his post op etc care once he returned home is covered under our medical system. It's a sweet deal.

 

 

You said it all.

And, I'm not going to comment more. My eyes are rolling too hard at all the "news" of that article to type straight.

[MtnTeaching]

According to the NY Times Europe page, it looks as if Britian may be moving away from their system.

 

"Britain Plans to Decentralize National Health Care" http://www.nytimes.com/2010/07/25/world/europe/25britain.html?_r=2&hp

[annandatje]

A fixture here in the USA are the gallon pickle type jars on convenience store checkout counters. The front of jar typically has a photo taped to it of a cancer ridden child or adult or an accident victim or someone in need of transplant. Customers toss dollars and coins into jar for the person whose family is unable to afford medical care.

[nmoira]

 

According to the NY Times Europe page, it looks as if Britian may be moving away from their system.

Restructuring, not moving away from. If it happens, it wouldn't be the first restructuring/reorganization.

[chiguirre]

I think we will see a change. I think the best and the brightest will start looking for careers other than surgery, because they don't want to be government employees.

 

I think they already are for the most part. The elderly are covered by Medicare and if you're disabled or seriously ill, you're likely to be covered by Medicaid. Of course, this depends on your patient population, but it's true of many specialties.

[C_l_e_0..Q_c]

 

The reason Canada wasn't able to perform the surgery itself is compared to the US we are population wise a small country.

 

309,786,000 is the population of the US (4.52% of the world population)

34,180,000 is the population of Canada (0.5% of the world population)

 

 

 

Not only that, but health coverage is provincial, not national. Each province pays for its own coverage. So PEI, with its population of 135,851 according to the 2006 census, has to finance all of its doctors? I doubt they have many specialists there! And Newfoundland, with its half-million, doesn't get very far either.

 

Travelling for health care is quite common.

[Mergath]

I can tell you from personal experience that the medical and dental coverage my children have under government-run Medicaid is far superior to the can't-afford-the-copay-to-see-the-doctor-for-an-obvious-infection care I get under my husband's crappy employer-sponsored health insurance plan.

 

Same here. When my husband had full-time work, we had insurance through his company. Our premiums were almost five hundred dollars a month, and we still couldn't afford to go to the doctor, because insurance only covered a portion of the bills, and every time we went we'd end up with hundreds or even thousands of dollars in bills left over.

 

Now we've got medical assistance through the state of Minnesota because we're broke and my dd has special needs. We pay no premiums, no co-pays, and all of our medical expenses are covered in full. We can go to any doctor we want in the state.

 

I look forward to the day that all low-income families can receive "socialist" health care.

Edited July 25, 2010 by Mergath

[MtnTeaching]

Restructuring, not moving away from. If it happens, it wouldn't be the first restructuring/reorganization.

 

 

Sorry - I wasn't clear on that one. I was thinking in terms of "moving away" from the government making the decisions and putting it into the hands of the doctors.

 

Looks like we've got a LOT of healthcare restructuring/reorganization in our future, too!